An elderly patient presented with an acute reaction of shingles. How soon after treatment is it advisable to administer the zoster vaccine (Zostavax)? A month? A year? I have gotten conflicting answers from both sides of the spectrum. — Anna Lisa Guzman, PA-C, MPAS, Edinburg, Tex.

Zostavax is recommended as a single subcutaneous dose for persons aged 60 years and older. The vaccine is contraindicated in persons with a history of allergy to gelatin, neomycin or other component of the vaccine; immunodeficiency (malignancy affecting bone marrow or lymph system, HIV, or AIDS); receiving immunosuppressive therapy, including high-dose corticosteroids; and pregnancy.

The CDC recommends that qualifying individuals be vaccinated regardless of extent of documentation of prior varicella or zoster. The CDC remains somewhat vague on the timing of vaccine after an outbreak of shingles. The published wording is, “The general guideline for any vaccine is to wait until the acute stage of the illness is over and symptoms abate.” — Claire Babcock O’Connell, MPH, PA-C (155-11)